DIAGNOSIS OF CHLAMYDIA-TRACHOMATIS URETHRAL INFECTION IN SYMPTOMATIC AND ASYMPTOMATIC MEN BY TESTING FIRST-VOID URINE IN A LIGASE CHAIN-REACTION ASSAY

A multicenter study compared ligase chain reaction (LCR) of Chlamydia trachomatis plasmid DNA with culture of urethral swab specimens from 5 42 men (study A); a second study (B) compared LCR offirst-void urine ( FVU) with urethral swab cultures from 1043 men. Discordant results wer e resolved with direct fluorescent antibody staining of sediments from the FVU or urethral culture specimen and with a second LCR directed a gainst a fragment of the major outer membrane protein gene. Test perfo rmance was calculated on the basis of an expanded reference standard. The LCR plasmid assay had a sensitivity of 98.0% in study A and 93.5% in study B; specificity was 99.8%-100%. The sensitivity of culturing u rethral swabs from all study sites was 68.2% (range by sites, 40.0%-84 .6%). The presence or absence of urethral symptoms did not alter the r esults. Use of this LCR test should allow more meaningful investigatio n and treatment of C. trachomatis infections in men.